plan analytics paint a realistic picture of your organization s health Impressionism has no place in your health care benefit plan. Arm yourself with the facts. Uses up-to-date client-specific data Clears up any assumptions Provides a call to action and fuels action at the leadership level
about the client statistics Since 2008 the company has doubled in size average age has increased marginally male/female ratio has remained stable Both Depression and Diabetes have consistently remained listed as a Top 5 Disease State over the past six years.
preparing for the new world the headlines vs. the bottom line
define the mandate plan metrics help develop an appropriate health & wellness strategy ensuring resources target the right areas links corporate health and wellness initiatives to member health uses predictive modeling to facilitate decision making and resource planning
the nitty gritty plan metrics included demographic profile and claimant level metrics coordination of benefits evaluation specialty drug evaluation / high users analysis saturation rates of age-related chronic conditions adherence to chronic therapies population and disease state metrics
claimant profile claimants by relation and gender 2011 2013 spouses & dependents combined account for more than 60% of claimants claimant spend is spread equally between males and females majority of claimants fall within the 25-54 year age band under 24 33.3% 25-54 57.8% over 55 8.9%
key findings Specialty drug therapies were the primary cost driver Remaining increase in spending resulted from a rise in the number of claimants Stop-loss provision pooling sheltered the plan from significant additional costs
key findings Coordination of benefits also helped shelter the plan from specialty spend Diabetes was the third most costly general therapeutic area in 2013 Depression has consistently ranked as one of the top disease states
key findings Several areas were identified where meaningful health & wellness initiatives could improve health outcomes
areas of focus targeting primary cost drivers Specialty Drug Therapies Age-Related Chronic Conditions Diabetes Mental Health Depression
specialty drug therapies there are two categories of specialty drugs Biological biological in origin, with highly focused targets in the body involve complex administration protocols Non-biological non-biological in origin, with highly focused targets in the body taken orally in tablet or capsule form Both are expensive and not affected by the cost savings available from generic substitutes.
specialty drug therapies Several employees treating their condition with conventional therapies were identified as posing an additional risk to the plan, should they progress to becoming specialty drug claimants.
specialty drug therapies specialty drug utilization employee vs. spouse / dependent claim ratio 2011 2013 76% vs. 24% 57% vs. 43% average specialty drug claim cost specialty drug $1,470 non-specialty drug $50
specialty drug therapies specialty drug spending top therapeutic categories Rheumatoid Arthritis Multiple Sclerosis (MS) Psoriasis Cancer Treatment High users represented 1.3% of all claimants. 38.0% of total plan costs prior to any stop loss results from high user claims.
specialty drug therapies The ability to afford specialty drug therapies depends on how cost-effectively we manage other areas of our program. Cost sheltering from generics will NOT be sufficient to sustain your program in the coming years.
age-related chronic conditions age-related chronic conditions examined for this study High Blood Pressure Elevated Cholesterol Diabetes Stomach Hyperacidity Osteoporosis
age-related chronic conditions Unlike Specialty Drug claims, the cost for chronic conditions results from the number of claims paid Only half of all high claimants ($5,000/year+) were Specialty Drug claimants
age-related chronic conditions chronic conditions and adherence average % of claimant adherence for the four most common chronic conditions adherent 52% non-adherent general / standard 48% adherent high blood pressure 56.9% 34.3% elevated cholesterol 49.5% 45.0% depression 43.7% 37.6% diabetes 41.4% 51.7% overall average 47.9% 42.1%
diabetes Diabetes has been identified by the World Health Organization as a global epidemic and is projected to be the 7th leading cause of death in 2030.
diabetes there are two types of diabetes Type 1 auto-immune disorder characterized by deficient insulin production and requires daily administration of insulin cause is unknown Type 2 results from body s ineffective use of insulin comprises 90% of diabetics world-wide largely the result of excess body weight and physical inactivity
diabetes disproportionate impact of diabetes on the plan Diabetes accounted for 19.6% of claims paid in 2013 Elevated blood sugar ranked 9th in 2011; 3rd in 2013 Diabetes has been steadily increasing over the past six years and has ranked first or second in plan spending over the last three years.
diabetes self-monitoring and diabetes 15 claimants did not appear to be self monitoring their blood sugar. Proper blood sugar monitoring is essential to effective disease management. claimants self-monitoring blood sugar but not yet claiming for drug therapy 2011 2012 2013 15 7 8
diabetes disproportionate spend for diabetic vs. non-diabetic claimants A diabetic claimant cost the plan 4.2x more than a non-diabetic claimant on a per capita basis In 2013, 80.5% of these costs were directly associated with the condition With coverage to age 67, the cost of eight pre-diabetics becoming diabetic at age 50, is $306,686.
diabetes prevention strategy The Canadian Diabetes Association suggests a three-pronged approach towards prevention create a broad-based diabetes prevention strategy target persons at risk promote secondary prevention strategies, such as workplace wellness programs
depression psychological health in the workplace Many factors outside of an employer's control can impact an employee s psychological health: Genetics Personal issues Family concerns Financial challenges The majority of mental workplace injuries result from abuse, harassment, discrimination and poisoned environments.
depression impact of depression on the plan in 2013 Contribution to overall plan costs in 2013 = 8.2% Bulk of spending on depressed employees came from claims treating other conditions. Antidepressants account for only 26.5% of plan spending for a depressed employee.
depression disproportionate spend for depressed vs. non-depressed claimants Depressed claimants cost the plan twice as much and had 2.3x more claims than non-depressed claimants on a per capita basis 33.9% of these costs were directly associated with the condition Nearly 1 out of 8 employees were treated for depression in 2013
depression depression and adherence A steep fall off rate of 14.2% after the first prescription fill is a prime concern in the treatment of depression. average % of claimant adherence for mental health conditions 56% non-adherent 44% adherent
depression treatment resistant depression incidence of treatment resistant depression has increased from 7.3% in 2011 to 17.8% in 2013 characterized by prolonged episodes of low mood and associated symptoms requires multiple, more costly drug therapies TRD claimants generally exhibit higher rates of short-term and long-term disability claims
depression what you can do to facilitate workplace mental health Understand the multi-faceted issues that drive Mental Health Build support mechanisms from corporate level downwards Properly train management Work to eliminate the stigma of Mental Health in the workplace Facilitate support programs Sponsor Return To Work programs for employees returning from disability
depression what you can do to facilitate workplace mental health Guides and Documents Psychological Health and Safety An Action Guide for Employers The Road to Psychological Safety Websites: http://www.workplacestrategiesformentalhealth.com/ http://www.guardingmindsatwork.ca/ http://www.psychologicallysafeworkplace.ca/ http://www.mentalhealthcommission.ca/
a call to action for employers action strategies Link corporate health & wellness initiatives to member health, ensuring that the plan is targeting correct areas Focus on high risk areas affected by lifestyle and habits Encourage healthy employee behaviour through plan design Be pro-active
the journey continues
questions & discussion